Chapter 7 Flashcards

1
Q

Mood disorders

A

Characterized by unusually severe or prolonged disturbances of mood; two major forms Depressive disorders and bipolar disorders

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2
Q

Depressive disorders (2)

A

AKA unipolar disorders; include major depressive disorder and persistent depressive disorder (Dysthymia)

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3
Q

Major depressive disorder

  • Diagnostic criteria
  • prevalence
A

Episodes of severe depression; occurrence of at least one major depressive episode in absence of history of mania or hypomania. At least one of symptoms is depressed mood or loss of interest

  • 12% men, 21% women, 16% overall 8%suffering now
  • most common type of mood disorder
  • half of depressed ppl fail to seek help; Lats and Blacks less likely to recive care than any other
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4
Q

mania vs. hypomania

A

state of unusual elation and energy vs. mild state of mania

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5
Q

MDD and occupational effect (3)

A
  • Billions lost in productive work time which is greater than costs of illnesses like CVD and diabetes.
  • Avg depressed worker earns 10% less
  • Major depression costs avg worker 27 lost workdays (bipolar is 65)
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6
Q

Risk Factors in MDD

4

A
  1. age of onset- common in young adults
  2. SES- lower is greater risk
  3. Marital status- separated at higher risk
  4. Women- twice as likely; begins in adolescene persisting thru middle age
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7
Q

Seasonal Affect Disorder

A

No diagnostic category but subset; classified as MDD with seasonal pattern; Cause unknown but may be due to changes in light which alter bodies biological rhythms and regulate temperature, sleep/wake cycles. Seasonal changes might effect serotionon. Use of phottherapy.

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8
Q

Postpartum depression

A

Nearly 80% have mood changes after childbirth; 1 in 7 have PPD affecting 10-15% following one year of childbirth. Women with PPD have MDE within four weeks of delivery. In 50% of all cases depressive episodes happen before birth. Most PPD episodes don’t last as long as MD.
-Diff from postpartum psychosis (losing touch with reality, hallucinations, delusions)

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9
Q

Persistent depressive disorder

  • prevalence?
  • How many go onto develop MD?
A

AKA Dysthymia (bad spirit); Typically begans in childhood or adolescence and follows chronic course of depression. Mild nagging symptoms lasting for years. 90% with dysth get MD; affects 4% of ppl

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10
Q

Double depression

A

Concurrent with depressive disorder and dysthymia

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11
Q

Premenstrual Dysphoric Disorder

-Prevalence rates

A

More severe form of PMS; cluster of neg physical and mood symtoms during period. Applies to women wo experience range of psych syptoms a week before period.
-Most have PMS (50%), 1 in 5 said it interfers with daily functioning, 2-5% of PDD

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12
Q

Bipolar disorder

- prevalence/onset/gender

A

Extreme mood swing between elation and depression, changes in energy. Manic episodes typically last few weeks to month and are shorter and end more abruptly than depressive episodes. Tends to be chronic. Two types depending on whether person has ever had full blown manic episode:
I- at least one full manic episode ( extreme mood swings with intervening periods of normal mood, possible for this to apply to those who have never had MDE)
II- Hypomanic episodes with history of one MDE
- some type II go onto develop I
- About 1% have either I or II; typically develops around age 20 in men and women with equal rates;

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13
Q

Rapid cycling

A

Person has two or more full cycles of mania and depression within a year without any normal periods. Occurs more often in women.

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14
Q

Manic episode

A

periods of unrealistically heightened euphoria, restlessness, excessive activity with disorganized behavior. Happens abruptly, differs from hypomania bc of severity, pressured speech, highly distractible.

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15
Q

Cyclothymic disorder

  • Prevalence
  • How many go onto develop Bipolar?
A

(circle spirit) chronic pattern of less severe mood swings than bipolar, cyclical pattern of moods lasting at least two years (I for child) Begins in early adulthood and persists for years. Few periods of normal mood last longer than month.

  • Most common bipolar disorder, 0.4-1% but underdiagnosed.
  • 1 in 3 eventually develop bipolar
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16
Q

Stress and depression

A

80% of those with MDD have source of major stress before onset. Stress assoc with interpersonal probs may contribute to those only with negative thinking.

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17
Q

Psychodynamic theory of depression

A

Freud states depression is anger directed against self; Occurs following actual or threatened loss of significant other. Mourning is normal process of psychologically separating self from person. Pathological mourning occurs in those who have ambivalent feelings (love and hate) towards person. When ppl lose this person their ambivalent feelings turn into anger/rage triggering guilt which prevents them from venting anger at lost person (object). To preserve psych connection to object they introject or bring inward a mental rep of object; anger then turned inward which leads to self-hatred/depression.

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18
Q

Psychodynamic view of bipolar disorder

A

Represent the shifting of dominance between ego and superego. In depressive phase the superego is dominant producing exaggerated notions of wrongdoing and flooding self with guilt. After time ego rebounds and asserts self-confidence that is the manic phase.

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19
Q

Self-focusing model

A

Modern psychodynamic view: considers how ppl allocate their attentional processes after a loss or personal failure. Views depressed ppl as having difficulty thinking about anything other than self or loss.

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20
Q

Humanistic view of depression

A

Depression occurs when ppl can’t imbue life with meaning and make authentic choices that lead to self fulfillment. May have frustrated our needs for self actualization or be settling. Focus on loss of self-esteem that occurs when we lose loved one or suffer occupational drawbacks. We tend to connect identity and self-worth to social roles as parents ect. and when these roles change we can lose self-worth.

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21
Q

Learning theory of depression

A

Peter Lewinsohn proposed that it results from imbalance between behavior and reinforcement. Lack of reinforcement for efforts can sap motivation which leads to depression. Inactivity and social withdrawal reduce opportunities for reinforcement.
- Low rate of activity in depressed ppl may be secondary reinforcement. Family members may rally around depressed ppl and relieve them of responsibilities. (sympathy becomes source of reinforcement that maintains depression)

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22
Q

Interactional theory

A

Developed by James Coyne; adjustment to living with depressed ppl may be stressful so much that the person becomes less reinforcing. Based on reciprocal interaction- one’s behavior influences how others respond to us. Depressed ppl react to stress by demanding reassurance and support which overtime elicits annoyance. These feelings surface in subtle ways.

23
Q

Cognitive theories of depression

-2

A

Relate origin and maintenance of depression to ways in which ppl see themselves and world

  1. Cognitive triad
  2. Cognitive specificity hypothesis
24
Q

Cognitive triad of depression

-becks ideas

A

Developed by Aaron Beck; links depression to adoption early in life of a negatively biased or distorted way of thinking. Negative concepts of self and world are mental templates adopted in childhood based on learning experiences
Triad: adopting negative views of self, environment, future
Beck beliefs cognitive distortions lead to depression

25
Q

Cognitive distortions assoc. with depression (10)

A

Developed by David Burns, distortions occur automatically

  1. All or nothing thinking- b/w; perfectionism
  2. Overgeneralizing- if neg event happens it will happen again
  3. Mental filter- (selective abstract) focus only on neg details
  4. Disqualifying the positive- denying accomplishments
  5. Jumping to conclusions- forming neg interps of events despite evidence; Mind reading (others don’t like you) and fortune teller error (predicting something bad happening always)
  6. Magnification & Minimization- make mountains outa molehills, catastrophizing neg events and minimize pos
  7. Emotional reasoning- base reasoning on emotions interp events on emotions rather than evidence
  8. Should statements- self commandments of shoulds and musts; musterbation is creating unrealistic expectations
  9. Labeling and Mislabeling- explain behavior by attaching neg labels to self or others
  10. Personalization- assuming that one is responsible for other ppls probs
26
Q

Cognitive-specificy hypothesis

A

By Beck; belief that diff emotional disorders are linked to diff automatic thoughts. Those with depression often report auto thoughts of loss, self-deprecation, pessimism. Those with anxiety report thoughts of physical danger or threats.

27
Q

Learned helplessness model

A

By Martin seligman; Behavior pattern characterized by passivity and perceptions of lack of control; ppl become depressed bc they view themselves as helpless to change bc of their experiences. Depression results from exposure to uncontrollable situations which instill expectation that future outcomes are beyond control (self-fulfilling prophecy)

  • Model is mix of cognitive and behavioral
  • based on studies with dogs showing learned helplessness effect by failing to escape when possible.
28
Q

Problems with theory of learned helplessness

A

Original failed to take into account low self esteem nor did it explain why some depression persists. New theory said perception of lack of control over future rewards did not itself explain persistence but need to consider cog factors.

29
Q

Reformulated theory of learned helplessness

-3?

A

Recast theory in terms of social psychology’s concept of attributional style- personal style of explanation; we explain failure or disappointment in various ways.
-Those who explain causes of neg events according to three types most vulnerable to depression:
1. Internal factors- failures reflect personal inadequacies instead of external/others
2. Stable factors- failure reflects fixed personality factors rather than unstable factors/ isolated event
3. Global factors- failures reflect sweeping flaws in personality rather than specific factors/ limited factors
All called negative attributional styles

30
Q

Biological view of

  • Twin studies
  • genetic links
A

Variations in genes controlling serortonin linked to greater risk of depression in face of stress

  • higher concordance rates among MZ twins providing stronger support for genetic contribution. Double concordance rate for MDD among MZ twins than DZ
  • gene variations common in: MDD, bipolar, schizo, autism, ADHD
31
Q

Biochemical and brain abnormalities in depression

  • cause of depression
  • antidepressants work?
  • brain imaging
A

Low levels of neuroTs doesn’t lead to depression bc antideps boos levels in brain within few days but takes weeks for full effect. Also evidence doesn’t show lack of neuroTs in depressive ppl. Possible that depression involves irregular numbers of receptors on neurons. Or abnormalities in sensitivity of receptors.

  • Work by altering number of receptors or sensitivity to neuroTs
  • brain imaging shows reduced size and low metabolic activity in mood disorder patients in areas involved in regulating thinking and processes of mood like prefrontal cortex and limbic system. NeuroTs regulate nerve impulses in prefrontal cortex. Endocrine system involved too
32
Q

Causal factors in bipolar disorder (6)

A
  1. cognitive deficits in recognizing facial cues of emotions in others, deficiencies tied to prefrontal c and limbic.
  2. Abnormalities in processing of emotions
  3. Higher genetic contribution than depression
  4. Finland study concordance rate seven times higher in MZ twins than DZ (43 vs 6%)
  5. High risk at greater paternal age at birth (father 55 or older)
  6. role of psychosocial factors: social support can offer buffer stress.
33
Q

Psychodynamic treatment of depression

A

Aims to help depressed ppl understand underlying ambivalent feelings towards ppl in lives whom they have lost. By working thru feelings of anger towards (object) they can turn anger outward thru verbal expression of feelings.
- ITP is a brief therapy emphasizing role of interpersonal issues in depression and helps ppl make changes in relationships. Focus on current relationships rather than past unconscious conflicts. Helps ppl deal with unresolved grief and role conflicts. Used for ptsd, bulimia, MDD, and dysthmia. Culturally appropriate for Africa.

34
Q

Behavioral treatment of depression

A

Focus on helping depressed ppl get more effective social or interpersonal skills and increase participation in rewarding activities.
- Behavior activation most used therapy; encouraging them to increase enjoyable activities

35
Q

CBT

A

most used therapy for depression; believe that distortions play role in development; depressed ppl tend to focus on how they are feeling rather than on thoughts that may underlie their feelings.

  • cognitive therapy founded by aaron beck a leading form of CBT focusing on helping ppl recognize and correct dysfunctional thinking.
  • CBT is usually brief. 14-16 sessions, help client connect thought patterns to negative moods by having them monitor auto neg thoughts in diary. Therapist then challenges and helps replace with rational ones.
  • Benefits comparable with drugs but most effective when combined.
36
Q

TCA’s (4)

A

Tricyclics; increase the availability of neuroTs norepinephrine and serotonin. Include: Imipramine(Tofranil), Norparamin, Amitripyline(Elavil) and doxepin (sinquan)

  • 3 ringed structure
  • highly toxic raising suicidal overdoses
37
Q

MAO inhibitors

A

Nardil, increases neuroTs by inhibiting action of monoamine oxidase (enzyme that breaks down neuroTs)
- less used bc they have serious interactions with foods and alcohols

38
Q

SSRI’s

A

effect serotonin levels by interfering with the reuptake of serotonin by neurons. Include: Fluoxetine(prozac), Sertaline(zoloft).

39
Q

SNRIs

A

work by increasing levels of serotonin and norepinephrine by interfering with reuptake. Include Venlafaxine (Effexor)

40
Q

Side effects of TCA’s and MAO’s

A

Dry mouth, slow motor, constipation, blurred vision, sexual dysfunction,
occurring less frequently: urinary retention, paralytic ileus, confusion, delirium and CVD like reduced blood pressure

41
Q

Antidepressants

  • success rates
  • differences
A

Full symptom relief only occurs 1 in 3 ppl and 2/3s of effectiveness explained by placebo effects.
- evidence shows little diff in them however SSRIs are less toxic and less dangerous with fewer side effects

42
Q

Antidepressants and relapse

A

May happen even in ppl who continue taking med but is reduced when meds continued months after symptoms are gone.
-CBT is best protection against relapse (a psych inoculation)

43
Q

ECT

A

100,000 undergo annually

70 to 130 volts applied to head to induce grand map seizure; given 6 to 12 times up to 3 times per week.

44
Q

Bipolar treatment

A

-Most used is drugs
- Greeks and Roman first to use lithium as form of chemotherapy; prescribed mineral water for mood swings
- Lithium carbonate is a powdered form of lithium to treat bipolar, helps reduce mania, ppl take it for life
- Don’t know how it works and some may not tolerate it
Toxic effects are mild memory probe, weight gain, lethargy, grogginess, slow motor and more serious is gastro distress and liver probe.
- more work should be done in treating depressive phase bc its most enduring and less responsive phase
- psych treatment may help boost adherence to meds

45
Q

Suicide

  • Thoughts vs. Attempts
  • Attempts vs. Successes
  • AIDS
  • Firearms
  • Mood disorders
A
  • 13% of adults have suicidal thoughts, 4% make attempt
  • 500,000 attempts and 33,000 successes
  • has twice amount of deaths than AIDS
  • more than half use fire arms
  • 60% of those who commit suicide suffer from mood disorder
46
Q

Suicide in college

A

Second leading cause of death in students; 1,000 suicides with 24,000 attempts between ages 18-24

47
Q

Suicide risk groups

  • age
  • gender (2)
  • ethnicity (3)
A

Highest in adults 65 years and older; especially white males.
More women attempt more men succeed. For every female suicide there are 4 male suicides.
More common among whites than blacks, asians, mexs. Whites twice as likely than blacks but native american teens have highest rates

48
Q

Rational suicide

A

Suicide with terminal illness; belief they are making rational choice

49
Q

Adolescents who have history of attempts

A

successful attempt is 14 times higher in females and 22 times higher in males than population

50
Q

Psychodynamic view of Suicides

A

Inward directed anger turns murderous; don’t seek to destroy self but seek to vent range on internalized representation of love of object/person. Freud said may be motivated by death instinct- tendency to return to tension free state that preceded birth

51
Q

Sociocultural view of suicide

A
  • belief that alienation may play role; moving around can cause isolation from social support and family may not be much help
  • Emile Durkeheim said ppl who experience anomie (loss of identity) are more likely to commit suicide
52
Q

Learning theory of suicide

A

Focus on lack of problem solving skills for handling significant life stress. Sneidman said those who attempt suicide wish to escape psycho pain and see no other way out. May also find sympathy when threatening or attempting suicide.

53
Q

Socio-cognitive theory of suicide

A

Suicide may be motivated by personal expectancies that one will be missed brothers or that surviros will feel bad.
Focus on potential modeling effects of observing suicide
Social contagion is spreading of suicide in community.

54
Q

Biological view of suicide

A

Genetic factors and neuroT serotionin. Serotonin acts to curb or inhibit nervous system activity so low levels may lead to disinhibit or realeas of impulsive behavior that can take form of suicide.